Racism in Therapy

As therapists we want to be seen as “good people.” But the moment we see ourselves without flaws is the moment we should stop being therapists.  It is also vital that we understand the ongoing racial disparity in therapy. Psychology routinely neglects the structural and historical legacies of racism.

In medical and psychological research, there is a historical lack of diversity within clinical trials. 2 months ago I did an essay for a diploma I am carrying out, on limitations within case conceptulisation in CBT and cultural biases. I was horrified at what I discovered: There is no meta-analytic reports on ethnic minorities. Funnily enough research on the whole of humanity is necessary for understanding and treating, well the whole of humanity! It is embarrassing and shameful and needs to change.

Another part was about therapists ourselves.

1.Those that ask questions around race and culture tend to only be therapists that have originally carried out studies in multiculturalism.

2.Most therapists are not educated enough to be culturally competent due to lack of training.

3.Studies with trainee therapists display that clients of colour tend to have to raise the topic of culture themselves to discuss it in the room.

4.Finally, research demonstrates that therapists (to be seen as good) “don’t see colour” and therefore don’t bring it up. What this colour-blind attitude does is leave you blinded, blinded of the client’s experience, create a safe space and ability to support them. If we omit racism, we are denying trauma.

Szymanski (2001) stated, “The relationship between White privilege and unequal power relations has remained relatively unacknowledged in the counselling and psychology literature. “ in my opinion, in the therapeutic room. Racism and privilege play a role within the clinical setting, thus imperative that clinicians have an understanding of racism and power dynamics, and if White; work on their privilege. We need to face up to the fact that we have chosen to work in a systemically racist professional body and actually DO something about it.


   

Understanding your triggers

Ever been in a situation where somebody is telling you a story and you get a PANG of emotion (fear, rage, anxiety, sadness)?
It may take you by surprise and leave you feeling confused. Thinking that it's disproportionate to what was happening...well you were triggered! Some of us are great at identifying these triggers and some of us need more help.
Triggers can be anything from environmental factors, opinions, certain words or even just people! Triggers also tend to have a physiological reaction: palpitations,dizziness, hot flushes, nausea etc.Identifying triggers is no easy feat but it will certainly serve you. Without becoming aware of triggers you are at the mercy of your emotions manipulating you.

• Pay attention to your physical reactions. Like the ones I outlined above.

• Be mindful of any thoughts or words that whizz through your head after the physical response

• Notice your surroundings: who are you with, what are you doing, what can you see?

• What were you doing before you were triggered?

• Keep a journal on your phone or at home. See if you can find a pattern

• Be patient! This takes practice and time so show yourself some self-care!

The Drama Triangle

The Drama Triangle by Stephen Karpman is one of my must commonly used tools with couples. It helps to give insight and understanding to the type of destructive interaction that occurs between people in conflict. I'm a firm believer that in order to understand what is occurring in conflict you must unpick what your role is first, before attempting to blame others. The Drama Triangle, also called the Victim Triangle, is a great starting point. 

Social Anxiety

Christmas time can be a challenge for sufferers of social anxiety, with the pressure to be festive and to socialise, it can be the most stressful time of the year. Those suffering with social anxiety can obsess about such issues until they prove debilitating. It is estimated that social anxiety disorder affects up to 10% of the UK's population. The NICE guidelines describe it as the "persistent fear of or anxiety about one or more social or performance situations that is out of proportion to the actual threat posed by the situation”. Most individuals struggle with their supposed social inadequacies. Alongside; paranoia, lack of confidence and low self-esteem.
If you go to the party (you are amazing and brave if you do!) here are some tips to help you through.
·  Plan ahead; set a time you would like to go and like to leave by. Make sure you will feel comfortable for this duration. Stick to your exit plan.
·  Limit alcohol; I know one of the easiest things to do is turn to booze, masking some of the feelings and giving yourself some Dutch courage. However, this is not going to be the most helpful. There is a strong correlation between anxiety and alcoholism. It may also perpetuate the anxiety in the future. ·  Plan on what you would like to talk to people about at the party. Think of topics and conversations that you enjoy and how you could integrate them in. Ask questions, most people love to talk about themselves so see if you can ask questions that may give you a common ground; sport, studies, music. Maybe avoid politics!
·  Look out for those on their own; find someone who may be on their own or broken away from the group. Most people will be delighted that they have been approached and will engage in chat.
·  Be kind to yourself; you are fab that you have gone in the first place. Tell yourself that! You deserve praise and admiration! Show it to yourself. Repeat after me; ‘I am amazing and brave. I am enough’.  

Sex and Communication

Sex and communication: The ability to talk honestly and openly is vital in order to have a fulfilling sex life. The skills to do so can be learned which will greatly improve your sexual satisfaction and your relationship. Its not an easy thing to do, some people fear being embarrassed or embarrassing their partners. Not to mention the fear of being rejected or the possibility of ruining their relationships. Finally that many people are nervous about starting the conversation in the first instance so they just keep to themselves. Let's be honest; talking about sex is a very sensitive and uncomfortable topic for most people. All of these worries are completely understandable.

The inner critical voice

The critical inner voice represents an internal enemy and may be thought of as a threat to self-actualization and self-fulfilment. It tends to encourage inwardness, doubt, self-criticism, self-denial and inadequacy. But this voice tends to originate from early life experiences that are internalized and carried, as ways we think about ourselves. Frequently, many of these negative voices derive from our parents or carers, as children we collect the negative attitudes that parents not only have towards their children but also project about themselves and the world around them.
Once you recognise that the voice(s) you have in your head, is not your voice you can gain clarity. Recognising instead that these attacks are derived from childhood experience. If you can identify your voice you can gain an incredible amount of strength and release some of the power it may hold over you.

The Galaxy

The other day I was sitting on my laptop doing a deep dive into @nasa information of our galaxies, solar system and planets.
I became heavily immersed in learning about how each part is developed and evolves. It reminded me of the curiosity I had regarding pearls and how they are formed, in a previous post.

In nature beauty flourishes from even the darkest of places, the toughest terrain, or the harshest of conditions... to go with this metaphor; we humans can too.

What I'm saying isn't to minimise or dismiss the awfulness that is trauma, abuse or neglect. Nor am I saying that tough times are supposed to facilitate magnificence. But to remind us that we are worthy of glory and space, to be adored and adorned, no matter how things have been for us.

Harm in Therapy

Harm in Therapy is not a widely discussed topic. It is one that tends to be shroud in fear and shame by therapists. Which I believe has a lot to do with the public ramifications of a complaint....but that's for another day!

I think its important for us therapists to know that harm can be caused by anyone of us. None of us insusceptible, we all have capacity to inflict a wound.
We must keep this in mind not just in our work, but in our trainings (ensuring we are stretching our professional lense), our supervision (ensuring we are engaging reflexively and bringing in transference), our self-work (bringing our biases to therapy), and to our integrity (apologising for mistakes, working within our scope, being mindful of dynamics).
And let's be fair, a whole lot fecking more!

Writing this up wasn't easy, there was a dearth of articles. So apologies as this isn't as clear and multifaceted as I would like.

Trust in Relationships

Trust is the core of healthy relationships. They cannot function or blossom without it.
The most basic, content moments will be splintered. Anger, resentments, fears, will be condensed and boundless.
Safety is fundamental to the evolution of a relationship. Rather than the repetitive nature of the mistrust cycle. I always encourage people to have conversations or reflections on what a breach of trust looks like to them. It is a subjective definition, whereby it can look different to everyone.

Burnout when trying to Conceive

There is so, SO, little written on sex when trying to conceive. In particular, if you've been trying for a while or struggling with fertility. Sex can lead to burnout, exhaustion, frustration and distress.
Desire can wilter and frustration can arise.
I know this post is easier said than done, but if you can find small ways of easing the already overwhelming time, the better: Talk with each other and to each other, find intimacy and moments of closeness outside the bedroom, bring new things in as often as you can, and be tender with yourselves.

I do want to add one thing to clarify! On the slide regarding saliva, you can absolutely have oral, just don't use it as lube!

*slides can be found on Instagram

Self-confrontation

Self-confrontation and self-regulation are absolute KEYS in having healthy relationships. Knowing when we are projecting our own issues and displacing what is happening internally, rather than onto our partner. Recognising that sometimes when we are pointing at them, our three fingers pointing back at us may also need to be investigated. It is our job to manage our own emotions.
To know what is ours to own and face it. Then redirect ourselves, apologise if needed, and do what is helpful to soothe ourselves.

Image Based Sexual Abuse

Image Based Sexual Abuse has severe and long-lasting effects on mental health and catastrophic consequences to daily living. This is amplified when there is no law protecting the victim. (Bates, 2016; Cecil, 2014).

These stats and referencing are from a report that I wrote, IBSA shouldn’t need the back up of studies, using empathy and common sense should be able to give an insight into the severe effects for victims. But we haven’t got legislation, and one way to gain traction is by demonstrating through reports (unfortunately when it comes to law and the government, empathy won’t suffice).

We must produce legislation which creates a safe environment for victims to come forward, to be confident in the Gardaí, and to prosecute the perpetrators of this crime. Otherwise with the digital age being ever-present and technology on the rise, this crime will expand and unless we protect the public; mental health issues and suicide will increase.

Finally I am so eternally grateful for the incredible hard work Irish women are doing including @meganjrenee
@drcarolinewest @kneevo @emconcannon

What is shame?

Today I found a research paper on shame. It discussed how children prone to feelings of shame in childhood were more likely – years later – to engage in a range of risky behaviours (whereas the propensity to experience guilt about specific behaviours appears to be a protective factor. BUT that's for another post!) Shame is a painful, self-conscious emotion. Feeling shame, means you're feeling that your whole self is wrong.

Shame keeps us in the same pattern of behaviour that is entrenched in self-flagellation. And in order to escape shame's self-diminishing effects, expressing contempt or criticism toward another person, or shaming them, re-locates one's own shame in the other. With that in mind, the emotion can be passed from generation to generation. Children behave in ways that make them culpable for the shame that belongs to their parents. The risky behaviour outlined in that paper (and many others) is self-destructive behaviour.
However, there is a way out. Firstly; shame means different things to different people. It is still a universal emotion but it manifests in different ways for most of us: It can be presented in comparison to others, perfectionism, criticism or perceived failure. Try gage when your shame feels triggered and how it physically manifests. Secondly; be mindful of what you do with it, especially around children. Finally, meet it instead with self-compassion. Kindness and self-care can go a long way to combating shame.

Vulvar cancer

A small post on a form of gynaecological cancer rarely spoken about. Vulva cancer is rare in people under the age of 50 and those who have not experienced menopause. There are over 1000 cases a year in the UK with 80% being in those over the age of 60. This does not mean that if you are experiencing any of the symptoms, or concerns below, you shouldn't go to your GP.
But firstly, what does the vulva include? :
the Bartholin's glands which are 2 small glands each side of the vagina
the lips surrounding the vagina (labia minora and labia majora)
the clitoris
Symptoms can be:
a lump or a wart on the vulva
persistent itch or/and tenderness of the vulva
an open sore on the vulva
pain when urinating
raised patches of skin; they can be red or white
Depending on the presentation or certain factors, vulva cancer can be treated by surgery, radiotherapy and chemotherapy or a combination of all three. There are lots of other signs, symptoms and risk factors for vulvar cancer. For more information, you and guidance @eveappeal has wonderful advice on their website.
Remember, if you are at all worried, ask your GP to refer you to a Gynaecologist.

Check your language

This is a great little tool to stop yourself from getting caught up on expounding yourself as emotion, to help halt a sense of permanency. Your feelings are absolutely important and valid, however they are not your entity. Changing phrases can actually be a very powerful shift in your brain; it stops a neuropathway being created that gives the emotion power to become an identity. It also facilitates the ability to take back control. Sitting with and being in emotions is incredibly important, but be careful not to submerge and loose yourself in a label.
So if you feel yourself getting overwhelmed, check the language your using and see if you can alter it with this exercise, while still not minimizing your experience.

Intimacy in older years

Intimacy and connection are just as important in later life as they are in younger years.The need for intimacy is ageless and you can enjoy sex for as long as you would like.
That being said, there are many biological changes that occur as a result of getting older, which may create changes in our sex lives and influence how we feel about ourselves and our body.
With men, testosterone levels gradually decline throughout adulthood; about 1% each year after age 30 on average. There are also changes in penile distensibility this means it may take longer to achieve full erections or be maintained. There can also changes in muscle contractions which can effect orgasmic and ejaculatory experiences.
For women decreases in estrogen may lead to vaginal dryness and painful penetration alongside slower sexual arousal.
Finally, any condition that affects your general health could also affect your sexual health. Specifically illnesses that involve the cardiovascular system, diabetes or hormonal problems that may increase with age. These can result in challenges to being sexually active.
None of these physiological changes can't be assisted and alleviated with medication, patience and communication.
Actually, the great thing is that sex can actually get better with age! With years of getting to know your body, no longer having some of the old and stressful distractions (such as work or raising children) and, if you're in a relationship; better knowledge of your partner. Adapting, expanding your mindset and communicating means sex never has to stop!

Active listening

Active listening is about being immersed and engaged in what another person is saying, REALLY saying. 𝐋𝐢𝐬𝐭𝐞𝐧𝐢𝐧𝐠 𝐢𝐬 𝐚 𝐝𝐢𝐚𝐥𝐨𝐠𝐮𝐞, 𝐢𝐭 𝐢𝐬 𝐜𝐨𝐦𝐦𝐮𝐧𝐢𝐜𝐚𝐭𝐢𝐧𝐠. Research suggests that we only remember between 25 percent and 50 percent of what we hear. That means that when you talk to your partner, friend or colleague for 10 minutes, you may be only paying attention to less than half of the conversation. As a result, you are not hearing the whole message, despite believing that you have. When I did my psychotherapy training we spent 2 months on purely listening. Not being allowed to talk or respond but to be present in what the other person is saying (verbal and non-verbal). Learning how to listen is a skill, but one any of us can master.⁣⁣⁣⁣
⁣⁣⁣⁣Some tips to become better at listening: Try continuously focusing on what the person is saying, be aware of their body language too, try park those thoughts that come in to interject or distract you, reflect back what is said, ask for clarification, and summarise what you have heard.⁣⁣⁣⁣
⁣⁣If you feel that someone isn’t listening to you, you can always ask if they are following what you have said or ask them what they have heard.⁣⁣⁣⁣
⁣⁣⁣⁣

The importance of being right.

If I can recommend anything to watch on Netflix and I can recommend a lot! Nanette by Hannah Gadsby is sitting at the top spot. Her ability to incorporate humour into a beautiful monologue about; trauma, internalized homophobia, misogyny, self-worth, mental health etc... is incredible. It's witty, intelligent, thought-provoking and relevant.
This quote in the picture is one of my favourites. One of the most prominent themes in our culture is the need to be right. It's something I work with regularly with couples in conflict. It erodes our ability to listen, reflect and learn. It is so deeply embedded in our culture, belief system and in the collective psyche that we never even pause to consider it. It would really serve us to inquire why it is more compelling to be right than to listen to others? Why is it more important to hold on to our pride than to show compassion? Why is it more important to hold onto our judgement than to learn? "We could paint a better world if we learnt to see it from all perspectives. Diversity is strength, difference is a teacher. Fear difference you learn nothing.

Sex is a journey

If you treat sex as a discovery of yourself and your partner you can you can dive into a layer of unknown intimacy previously veiled by the goal of orgasms! We often think that climaxing is the holy grail, however when we take orgasms off the table, anxiety can decrease and pleasure can increase. If the objective is to enjoy yourself rather than reaching a crescendo, you can begin to uncover aspects of yourself that were shrouded by performance.

Your inner dialogue

If you wouldn’t say it to a friend, why would you say it to yourself? This is my question to you today: Why would you? We tend to talk about self-care in the context of actions and behaviours. We don't talk enough about the language that we use and the internal dialogue (or narrative) we subject ourselves to. 
The critical inner voice is a well-integrated pattern of destructive thoughts. It is an internal enemy that utilises negative thoughts, biases and beliefs against you. As a result the voice impacts on your confidence and self-esteem. So perhaps a form of self care this week could be challenging that inner critic. You can do so by : 1. Noticing the words, attitude AND TONE that you use towards yourself. 2. Challenging them, ask yourself; "if this happened to (insert friend/relative) what would I say to them?" 3. Ask yourself why you're not saying those (presumably lovely!) things. 4. Say those (presumably lovely!) things to yourself. Challenging yourself is actually cathartic, therapeutic and a great form of selfcare.